Tuesday, 5 January 2010

'More research is needed...'

No, greater moral fibre and more action

Evidence-based pride and observational prejudice
It is a truth universally acknowledged that a medical intervention justified by observational data must be in want of verification through a randomised controlled trial.

Smith, G. C. S., Pell, J. P.(2003) Parachute use to prevent death and major trauma related to gravitational challenge: systematic review of randomised controlled trials, British Medical Journal, vol. 327, pp. 1459-1461

Thanks to Sue O'Reily for drawing attention to this jolly but all the same important article.

This article has been subsequently cited by a large number of other papers in the medical press. Here is an example (italics in original):

Waiting for the results of randomised trials of public health interventions can cost hundreds of lives, especially in poor countries with great need and potential to benefit. If the science is good, we should act before the trials are done

In 2003 Smith and Pell published an entertaining but profound article titled: "Parachute use to prevent death and major trauma due to gravitational challenge."1 They used the lack of randomised controlled trials in testing parachutes to show that situations still exist where such trials are unnecessary. We argue that the parachute approach, where policies are set based on good science but without randomised trials, is often more suitable in resource poor settings. We use the examples of oral rehydration therapy, male circumcision to prevent HIV infection, and misoprostol for postpartum haemorrhage to show how an overemphasis on randomised controlled trials in poor settings poses important ethical and logistic problems and may incur avoidable deaths.

Potts, M., Prata, N., Walsh, J., Grossman, A. (2006) Parachute approach to evidence based medicine, British Medical Journal, vol, 333, pp. 701-703
http://www.bmj.com/cgi/content/full/333/7570/701

Is the provision of services to motor disordered children and adults, and their families, in the developed countries such as to be considered as 'a poor setting' You bet it is, often, financially, intellectually and morally. Hunt around in this literature for plenty such articles to give you heart amongst the Yahoos.

And stand up for sensible human judgement.

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